Facet Injection & Facet Rhizotomy

Facet Injection and Facet Rhizotomy are both surgical treatments for facet joint arthritis which involve treating facet pain and inflammation.

At each level of the spine, there is a set of facet joints, which make up a spinal motion segment. this spinal motion segment links each vertebra with the one above or below it, allowing for some movement while preventing against excessive rotation, flexion, extension, or lateral movements. Each facet joint is composed of the a facet from each of the two vertebra, smooth cartilage between the facets, and a capsule of connective tissue to hold the structure together. The facet joints may become injured due to the natural again process, which causes volume of healthy cartilage to decrease throughout the body. The facet joints may also become inflamed due to systemic inflammatory disease, infection, and instability to that area of the spine due to degenerative conditions to other structures of the spine. If the facet joints do become inflamed or degenerated, patients may experience back pain as well as referred pain patterns that you would typically degenerative disc disease. In addition, inflammation and arthritis to the facet joints may cause instability of the spine and injury to other structures. Surgical treatments for inflammation and facet joint arthritis may include facet injection or facet rhizotomy. But patients, under the direction of their doctors will typically give more conservative treatments to work before taking one of these approaches.

Conservative treatments for facet joint conditions include:
  • Physical therapy. Patients may go to several treatment sessions where they learn back pain exercises to strengthen the areas around the facet joints, to stabilize that area of the spine. Exercises and stretches that may decrease inflammation in stiffness in the affected facet joints include the hamstring stretch, piriformis stretch, and single knee to chest stretch. These back pain exercises are designed to reduce pain and associated stiffness in the lower back muscles and facet joints of the lumbar spine.
  • Patients may consult with a doctor or specialist who specializes in evaluating a person's posture, and how they use their body while sitting, walking, and moving. Bad posture can put a lot if pressure on the facet joints. Continued bad posture may stretch the ligaments of the spine, causing decreased support for the facet joints they are connected to.
  • Heat and Cold therapies may help to increase range of motion around these joints, or to decrease inflammation around the joints.
  • A person may modify their work commute, workplace tasks and conditions, or lifestyle in order to relieve some of the pressure on their achy facet joints.
  • Medications. Medications that treat pain and inflammation may provide patients with some relief. Oral pain medications appropriate to facet conditions include NSAIDs, and Celebrex, a Cox-2 inhibitor.

When conservative treatments do produce enough back pain relief, patients may receive injections, which are either designed to block pain signals from reaching the brain, decrease inflammation to the area in and around the facet joint, and to destroy the nerves transmitting pain signals away from the injured spinal joints. Steroid Injections. Facet injections, which deliver steroids (corticosteroids) to the joints causing the pain, may be successful at reducing inflammation and blocking the transmission of pain signals to the brain. Facet Rhizotomy is a technique that involves destroying some of the nerve fibers around the arthritic or inflamed facet joint in order to block the transmission of pain signals. With this procedure, a probe is guided into the nerve endings around the joint, and are destroyed using either an electrified hot probe technique or a tip that kills the nerves by freezing them.